basic tests done in the lab AND INTERPRETATION

1. LAB TEST
INTERPRETATION
AND TESTS
WALTER WASWA
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2. • Red Blood Cells (RBCs)
• Hematocrit (Hct)
• Hemoglobin (Hgb)
• Mean Corpuscular Volume (MCV)
• Mean Corpuscular Hemoglobin(MCH)
• Mean Corpuscular Hemoglobin
• Concentration (MCHC)
• Red cell distribution width (RDW)
• White Blood Cells (WBCs)
• Platelets
• Mean Platelet Volume (MPV)
CBC COMPONENTS
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3.  Transport hemoglobin which carries oxygen
from the lung to tissues throughout your body
 Produced in the bone marrow and stimulated
by erythropoietin which is made in the kidneys
M: 4.20 to 5.80 m/uL
F: 3.80 to 5.20 m/uL
RBC
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4. Hemoglobin :
M: 13.0 to 17.5 gm/dL
F: 11.5 to 15.5 gm/dL
Hematocrit : Percentage of the
volume of whole blood that is made
up of red blood cells. (Hint: Hb x 3)
M: 38 to 54 %
F: 34 to 46.5 %
HEMOGLOBIN AND HEMATOCRIT
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5. MCV = mean corpuscular volume
HCT/RBC count= 80-100fL
• small = microcytic
• normal = normocytic
• large = macrocytic
MCH= mean corpuscular hemoglobin
Hb/RBC count= 27-34 pg
• decreased = hypochromic
• normal = normochromic
• Increased = hyperchromic
MCV and MCHC
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6. • MCHC = mean corpuscular
hemoglobin concentration
Hb/HCT = 32- 36 gm/dl
• RDW = red cell distribution width
It is correlates with the degree of
anisocytosis or variation in red
blood cell width.
Normal range from 10-15%
MCHC and RDW
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7. Hemoglobin
Elevated
• Primary erythrocytosis
-Polycythemia Vera
• Secondary erythrocytosis
-Chronic hypoxia(COPD,
heart disease, high
altitude)
-Elevated erythropoietin
due to malignancy
Low
• Anemia
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8. How to Approach Anemia
• Decreased production of RBC’s
- ex. bone marrow failure, nutritional
deficiencies
• Increased destruction of RBC’s
- ex. hemolysis
• Loss of RBC’s
- ex. bleeding
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9. Microcytic
< 80 fl
MCV
Normocytic Macrocytic
> 100fl
IronDeficiencyIDA
ChronicInfections
Thalassemias
SideroblasticAnemia
Chronicdisease
EarlyIDA
Sicklecelldisease
Combineddeficiencies
Bloodloss
B12/Folatedeficiency
Hemolysis
MDS
MCV Differential
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10. Hypoproliferative Hyperproliferative
Retics < 2 Retics > 2
–Nutritional deficiencies
–Chronic disease
–Bone marrow failure
Hemolytic anemia
Chronic blood loss
Retic Count Differential
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11. Microcytic Anemia
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12. Iron Deficiency Anemia(IDA)
Ironrelated tests Normal IDA
SerumFerritin (pmo/L) 33-270 < 33
TIBC(µg/dL) 300-340 > 400
SerumIron (µg/dL) 50-150 < 30
TransferrinSaturation % 30-50 < 10
RDW 10-15% > 15%
MCH 27-34 <27
Reticcount - < 2
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13. STAGES OF IRON DEFICIENCY
Marrow iron +++ None None None
Ferritin 40- 200 20-30 10-15 < 10
MCV Normal Normal Slightly
microcytic
Microcytosis
Anemia Absent Absent Absent Present
TIBC Normal Normal Norma or
Increased
Increased
Serum Iron 60- 150 < 40 < 20 < 10
Transferrin Sat % 20-50 30 <15 < 15
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14. Etiology of Iron Deficiency
• Blood loss
-GI, menstruation, hemoptysis, dialysis
• Increased iron requirements
-Pregnancy, erythropoietin therapy
• Inadequate iron supply
-Poor dietary intake, vegan, malabsorption(IBD,
celiac disease, gastric bypass)
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15. Treatment for IDA
• Oral iron is first line treatment (ferrous
sulfate/gluconate)
A. Ca-tums, Phosphate, antacids ↓absorption
B. Ascorbic acid (orange juice)↑absorption
• Reserve parenteral Rx. for oral intolerance
• Packed cell transfusion in emergency
• Continue Fe Rx at least 3 months after normal
Hb
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16. Macrocytic Anemia
• - B12(Cobalamin) and Folate deficiency
-Drugs (hydrea, 5-FU, MTX, HIV meds)
- Liver disease/alcohol
-Hypothyroidism
-Myelodysplastic Syndrome
-Hemolysis
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17. Etiology of B12/Folate
Deficiency
B12
• Impaired absorption
-Gastric atrophy, PPI,
*Pernicious anemia, Gastric
bypass, Crohn’s disease,
Celiac disease
• Poor dietary intake
-Strict vegan
• Defect in transport
Folate
• Impaired absorption
Crohn’s disease,Celiac
disease, decreased
duodenal and ileal
absorption
• Poor dietary intake
-*Tea and toast diet,
Alcoholism
• Increased requirements
-Pregnancy, hemolysis
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18. B12(Cobalamin) Deficiency
• Symptoms : weakness, depression, memory loss, unsteady
gait and clumsiness (posterior and later columns
degeneration)
• Diagnosed by B12 levels< 200 pg/ml
• Methylmalonic acid and homocysteine elevated in early
deficiency
• Tx: oral B12 or B12 IM injections
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19. Folate Deficiency
• Symptoms: Similar to B12 deficiency, except
no neurological symptoms
• Diagnosed by folate < 2 ng
• Tx with folate 1-5mg/day
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20. Normocytic Anemia
1. Chronic disease
2. Early IDA
3. Hemoglobinopathies(SCD)
4. Primary marrow disorders
5. Combined deficiencies( ex: Iron+B12)
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21. Anemia of Chronic
Disease(AOCD)
• Thyroid diseases
• Malignancy
• Collagen Vascular
Disease
-Rheumatoid Arthritis
-SLE
-Polymyositis
-Polyarteritis Nodosa
• IBD
– Ulcerative Colitis
– Crohn’s Disease
• Chronic Infections
– HIV, Osteomyelitis
– Tuberculosis
• Renal Failure
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22. Iron Deficiency Anemia vs AOCD
IDA AOCD
Serum ferritin Decreased Normal or
increased
Serum Iron Normal or decreased Normal or decreased
TIBC Increased Normal or
decreased
Iron saturation Decreased Normal or decreased
MCV Decreased Normal or decreased
Bone marrow iron Decreased Normal or
increased
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23. • WBCs are involved in the immune response
• The normal range: 3.5 – 10.5x10^9 K/L
• Two types of WBC:
1) Granulocytes consist of:
– Neutrophils: 50 - 70%
– Eosinophils: 1 - 5%
– Basophils: up to 1%
2) Agranulocytes consist of:
- Lymphocytes: 20 - 40%
– Monocytes: 1 -6%
White Blood Cells (WBC)
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24. Neutrophilia – an increase in neutrophils
• Bacterial infections
• Tissue destruction (burns)
• Inflammation (SLE, RA, UC)
• Thyrotoxicosis
• Cigarette smoking
• Corticosteroids
• B-agonist
• Leukemia
Neutrophil
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25. Neutropenia – a decrease in neutrophils
• Decreased bone marrow production
• Medications ( ex. dapsone, cephalosporins)
• Immune related (ex. SLE, RA)
• Post acute infection (HSV, CMV, HIV, EBV)
Neutrophil
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26. Eosinophilia: increased eosinophil count
• Parasitic infections
• Allergic conditions and hypersensitivity reaction
• Aspergillosis
• Vasculitis
Eosinopenia
• Sepsis
Eosinophil
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27. • Lymphocytosis – increased lymphocyte count
_ Viral infection( EBV, CMV, HIV, Infectious )
mononucleosis
-Leukemia/Lymphoma (CLL)
• Lymphopenia – decreased lymphocyte
count
_Viral infections
_Medication induced
_ Autoimmune disorder
Lymphocyte
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28. Monocytes
• Monocytosis
-Pregnancy
-TB
-Syphilis
-Sarcoid
• Monocytopenia
- Acute infection
- Steroids
-Leukemia
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29. Platelets
• Platelets/thrombocytes principal function is
to prevent bleeding
• The normal range is 150-400 K/UL
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30. • Numbers of platelets
– Increased (Thrombocytosis)
• Splenectomy
• Inflammation(Reactive)
• Myeloproliferative disease (ET)
• Iron deficiency anemia
– Decreased (Thrombocytopenia)
• TTP, DIC, ITP, HIT*****
• Blood loss
• Splenomegaly
• Medications ( antibiotics)
• Viral Infections
• ETOH abuse
• Bone marrow disorder (leukemia)
Platelets
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31. CREATININE
?
• a kidney infection
• glomerulonephritis, which is inflammation of
the kidney structures that filter the blood
• kidney stones that block the urinary tract
• kidney failure
• Serum creatinine level · For adult men, 0.74 to
1.35 mg/dL (65.4 to 119.3 micromoles/L) · For
adult women, 0.59 to 1.04 mg/dL (52.2 to 91.9
...
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32. RBS
• A blood sugar level less than 140
mg/dL (7.8 mmol/L) is normal. A
reading of more than 200 mg/dL
(11.1 mmol/L) after two hours
indicates diabetes. A reading
between 140 and 199 mg/dL (7.8
mmol/L and 11.0 mmol/L) indicates
prediabetes
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33. HbA1c
A normal A1C level is below 5.7%,
a level of 5.7% to 6.4% indicates
prediabetes, and a level of 6.5% or
more indicates diabetes. Within
the 5.7% to 6.4% prediabetes
range, the higher your A1C, the
greater your risk is for developing
type 2 diabetes
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34. CRP
CRP is a protein made by
your liver. It's sent into your
bloodstream in response to
inflammation
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35. 35

36. LFTS
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37. Normal test range for an adult: 0.40 -
4.50 mIU/mL (milli-international units
per liter of blood). T4: thyroxine tests
for hypothyroidism and
hyperthyroidism, and used to monitor
treatment of thyroid disorders. Low T4
is seen with hypothyroidism, whereas
high T4 levels may indicate
hyperthyroidism.
TFTs
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